It is 20 years since the Conservative government of the day forced the NHS to take bids from private contractors. Health Editor MADELEINE BRINDLEY examines the impact of the private sector on the NHS

IN the early years of this new century Aneurin Bevan's 55-year-old dream of cradle-to-grave state health support seems far off the mark.

Instead we now have an NHS that can only just provide for each patient's journey through life with a little help from its private sector friends.

Two decades ago Margaret Thatcher unleashed compulsory competitive tendering on the NHS, today New Labour - which described such a process as "damaging" to the health service - presides over similar private contracting, only under the less alarming title of public private partnerships and its more controversial cousin, private finance initiatives.

Call it what you will, private involvement in the state provision of health services is here to stay, and fears of privatisation by the back door aside, it is doubtful whether the NHS could survive without its help.

Health Minister Jane Hutt, in a speech about the future of the NHS two years ago, declared, "The private, voluntary and independent sectors are an integral part of the care system."

NHS Trusts, particularly in England, where the lash of the political whip appears to be harsher than on this side of Offa's Dyke, are increasingly turning to private companies to help them meet their waiting list targets. Newport-based Medinet is just one example of a company working alongside the NHS to reduce waiting lists and offering treatment solutions to patients on those waiting lists.

Privately-run hospitals are taking increasing numbers of NHS patients as under-pressure health service hospitals realise they cannot operate on all those patients they must.

It would appear the future of the UK's hospital building programme rests largely on the private sector's shoulders - even in Wales, which has rejected a large-scale PFI programme, our newest hospitals have been built and will be run for decades by private contractors under lucrative deals with the NHS.

And where would health and social care of elderly people be without the private and independent sectors? All nursing home care is now provided by companies and individuals outside the state after government abandoned responsibility for this much needed service.

But still the debate about the extent to which private companies, which after all are in business to make a profit unlike the NHS, should be allowed to permeate the health service.

There has been widespread criticism of the private sector's presence in the NHS, not least the alarming claim it is privatisation by the back door and an apparent fall in standards in both catering and cleaning - two of the most commonly contracted out services.

Successive reports have highlighted the paucity of nutritious and warm meals offered in some hospitals that have contracted out catering to private sector companies and, in the age of the ever-present superbug MRSA, there is mounting concern about standards of cleanliness and the low pay of cleaners as some companies have been accused of putting profit above necessary and essential hygiene.

Ultimately it is the dichotomy of businesses operating in a not-for-profit organisation, such as the NHS and, more recently the nation's education system, that has prompted the widely held fears about privatisation. But as the NHS struggles to meet the demands of its patients on limited resources it is a conflict that must be resolved.

Our successive political masters have created an NHS where private involvement is almost enshrined in its very existence - the jury is split as to whether the NHS could stand alone in today's climate without such help.

It leaves us with the uncomfortable question of whether it is wise to bite off the hand that helps to care for us as our dependence on the NHS is only set to grow.